This presents for us a vast topic area, in this article we’ll aim to give a brief overview of the methods to approach making sense of sources available. However, in future posts we’ll delve a little deeper into more specific areas of mental health research and cannabinoids including CBD, THC and CBG. For clarity, when we use the term mental health problems, it refers to the broad spectrum of different classifications, this includes anxiety and depression as well as more serious mental illness (SMI) such as bipolar disorder and psychosis.
There are many questions that occupy us when scanning the evidence base for research on cannabinoids. But before reviewing the evidence, it’s worth considering that academia requires significant funding. To do this, there need to be a significant push either from industry, governments or charities. Because cannabinoids, namely THC have historically been illegal in many countries, we are likely many decades behind the extensive studies performed to test benefits, with researchers generally steered to probe harms instead. This presents an inevitably skewed perception. Nonetheless, there is a growing body of research which represent exciting and new findings.
Our readership is vast, so we want to share with you how we try to make sense of it all. When considering the evidence base for cannabinoids and mental health, it’s important to consider a few factors or questions:
- Is there any published research in for specific mental health problems?
- What is the quality of the research?
- Do the outcomes demonstrate improvements in indicators for mental health and wellbeing?
- Do the outcomes present a deterioration in mental health indicator outcomes?
- If there is no research, are other sources available?
- To what extent does anecdotal evidence become strong? If ever
PubMed is one of our favourite libraries, it’s quick, easy to navigate and well organised. You’ll see in one of our previous blogs titled ‘Overview of Cannabinol (CBD). A Review of the Scientific Literature’ our post is heavily referenced, much of which was found on PubMed searches. When using the search term ‘CBD mental health’, 123 results appear. By way of comparison, when searching for ‘alcohol mental health’, 211,88 appear and for ‘smoking mental health’, 87,00 appear. So when answering the first question, yes there is research but a small amount when compared to assessing the outcomes for mental health with other substances. However, PubMed generally shows individual studies no matter how small or large they are.
When thinking about question 2, the Cochrane Library is an invaluable resource, where quality is of an exceptionally high standard, most commonly in the form of systematic reviews. Unfortunately, there is a dearth of high quality research available here, the search term ‘CBD mental health’ shows one result from a very interesting review titled ‘Cannabis‐based medicines for chronic neuropathic pain in adults’. The review included 16 studies with 1,750 participants, much of the research included THC and CBD and the authors concluded:
- ‘There is a lack of good evidence that any cannabis‐derived product works for any chronic neuropathic pain.’
- ‘The optimal ratio of THC/CBD still needs to be determined.’
- ‘…pure CBD products or the development of peripherally acting cannabinoid agonists may reduce central nervous system and psychiatric adverse events.’
We think these findings are promising and show the early stages of research. Interestingly, the Cochrane Library shows a further 19 trials currently registered for future publication. So, new findings are on the horizon and more high-quality reviews for CBD and mental health will be published very soon.
For questions 3 and 4, there are unfortunately no binary answers. There are some studies which show improvements and others which show deterioration, this is likely related to the findings in the Cochrane Review and the need to TCH and CBD ratios to be honed, particularly in scientific studies. A very interesting review titled ‘Medicinal cannabis for psychiatric disorders: a clinically-focused systematic review’ summarises the implications of current research from a number of studies and says:
- ‘Medicinal cannabis has been reported to have potential efficacy in reducing pain, muscle spasticity, chemotherapy-induced nausea and vomiting, and intractable childhood epilepsy. Yet its potential application in the field of psychiatry is lesser known.’
And then concludes
- ‘There is currently encouraging, albeit embryonic, evidence for medicinal cannabis in the treatment of a range of psychiatric disorders. Supportive findings are emerging for some key isolates, however, clinicians need to be mindful of a range of prescriptive and occupational safety considerations, especially if initiating higher dose THC formulas.’
Again, promising findings but the inclusion of THC in many of these studies appears to have skewed the ability to test CBD as a standalone cannabinoid.
Question 5 and non-scientific sources. The internet, media and word of mouth are increasingly saturated with perceptions of CBD and cannabinoids. There is a lot of noise and analysis of google trend data for the search term ‘CBD’ in the UK, shows a big increase from February 2018. This increase in interest does not guarantee objective or high-quality information. But there are numerous testimonies, perhaps skewed towards positive experiences where people have claimed CBD has helped them with mental and physical health problems, mild to severe. Undoubtedly, these need to be interpreted with caution but shouldn’t be completely discredited, these are qualitative experiences which should drive research questions.
Number 6, there’s no rule to determine when anecdote becomes strong, but more noise tends to increase confidence. The becomes difficult in the current regulatory framework in the UK. We have had outstanding feedback from our range, some of which has exceeded our own expectations. Our CBD Oil 20% and our CBD Pain Relief Gel are by far our biggest sellers, but we’re unable to explicitly share this feedback or have a review section on the product pages, due to the restrictions on health claims. This to some extent, prevents the ability to accumulate anecdote and share people’s experiences.
Finally, we know what it’s like researching CBD, there’s lots of noise, information and claims being made. Assessing evidence and making an objective decision takes time and the CBD market remains fairly immature. Determining which product at which strength and delivery mechanism may take trial and error. If benefits are felt, it’s important to reflect, learn and see if this can be corroborated by evidence. Scientific research is needed but it is slow and outcomes need to be meaningful, particularly for mental health where the indicators are more subjective. We’d love to know your thoughts, comment and share.